摘要
目的探讨刺激性甲状腺球蛋白(sTg)联合治疗剂量^(131)I SPECT/CT显像及颈部超声对分化型甲状腺癌(DTC)术后再次^(131)I治疗患者颈部淋巴结转移的诊断价值。方法回顾性分析2021年12月至2024年7月济宁市第一人民医院收治的102例DTC术后甲状腺球蛋白抗体阴性且sTg≥1.0 ng/ml行再次^(131)I治疗的患者,其中男性37例、女性65例,年龄(45.5±11.7)岁,范围19~75岁。所有患者^(131)I治疗前1 d检测血清sTg并完成颈部超声检查,治疗后72~96 h行^(131)I全身显像(WBS)及颈胸部^(131)I SPECT/CT显像。以组织病理学检查结果或临床综合诊断结果为"金标准",根据患者有无颈部淋巴结转移分为淋巴结转移组和非转移组。计量资料的组间比较采用Mann-WhitneyU检验。采用受试者工作特征曲线评估sTg及^(131)I SPECT/CT显像中颈部病灶感兴趣区(ROI)最大标准摄取值与同层面胸锁乳突肌ROI的平均标准摄取值的比值(R/M)对DTC术后再次^(131)I治疗患者颈部淋巴结转移的诊断效能,并计算曲线下面积(AUC),根据最大约登指数确定sTg及R/M的最佳临界值。纳入sTg、R/M及颈部超声检查结果进行二元Logistic回归分析,并构建综合诊断模型。评估单独sTg及其联合多模态影像对DTC术后再次^(131)I治疗患者颈部淋巴结转移的诊断效能。采用Delong检验比较不同方法(单独sTg、sTg联合超声、sTg联合^(131)I SPECT/CT、综合诊断模型)的AUC的差异。结果(1)淋巴结转移组(47例)与非转移组(55例)患者血清sTg水平分别为27.05(10.75,53.79)ng/ml和4.41(1.71,4.66)ng/ml,R/M分别为2.15(1.97,2.36)和1.55±0.20,差异均有统计学意义(Z=-6.175、-5.719,均P<0.001);sTg和R/M诊断DTC术后再次^(131)I治疗患者颈部淋巴结转移的AUC分别为0.878(95%CI:0.788~0.968)和0.927(95%CI:0.862~0.991),最佳临界值分别为22.32 ng/ml和1.89。(2)sTg联合颈部超声诊断的AUC为0.926(95%CI:0.863~0.988),与单独sTg诊断的AUC的差异无统计学意义(Z=-1.417,P=0.156);sTg联合^(131)I SPECT/CT诊断的AUC为0.982(95%CI:0.952~1.000),综合诊断模型诊断的AUC为0.985(95%CI:0.962~1.000),均显著高于单独sTg诊断的AUC(Z=-2.379、-2.480,P=0.017、0.013);综合诊断模型的AUC显著高于sTg联合颈部超声(Z=-2.008,P=0.045)。结论sTg联合^(131)I SPECT/CT及颈部超声的综合诊断模型可显著提高DTC术后再次^(131)I治疗患者颈部淋巴结转移的诊断效能,为临床治疗决策提供依据。
Objective:To explore the diagnostic value of stimulated thyroglobulin(sTg)combined with therapeutic dose ^(131)I SPECT/CT imaging and neck ultrasound for detecting cervical lymph node metastasis in patients with differentiated thyroid cancer(DTC)who underwent ^(131)I treatment again after surgery.Methods:A retrospective analysis was conducted on 102 patients with DTC who underwent ^(131)I treatment again after surgery at Jining First People's Hospital from December 2021 to July 2024 and who had negative thyroglobulin antibody and serum sTg≥1.0 ng/ml.The patients included 37 males and 65 females,with an average age of(45.5±11.7)years,ranging from 19 to 75 years.All patients had their sTg levels measured and underwent neck ultrasound one day before ^(131)I treatment.At 72 to 96 hours after treatment,^(131)I whole-body scan(WBS)and neck-chest ^(131)I SPECT/CT imaging were performed.The results of histopathological examination or clinical comprehensive diagnosis were taken as the"gold standard".The patients were divided into the lymph node metastasis group and the non-metastasis group based on the presence or absence of cervical lymph node metastasis.The Mann-Whitney U test was used to compare measurement data between groups.Receiver operating characteristic curve was used to evaluate the diagnostic efficacy of sTg and the ratio of the maximum standardized uptake value of the cervical lesion region of interest(ROI)to the mean standardized uptake value of the sternocleidomastoid muscle ROI(R/M)in ^(131)I SPECT/CT imaging for cervical lymph node metastasis in DTC patients who underwent ^(131)I treatment again after surgery.Area under curve(AUC)was calculated.The optimal cut-off values of sTg and R/M were determined based on the maximum Youden index.Binary Logistic regression analysis was performed using sTg,R/M,and neck ultrasound examination data.A comprehensive diagnostic model was constructed to evaluate the diagnostic efficacy of sTg alone and its combination with multimodal imaging for cervical lymph node metastasis in DTC patients who underwent ^(131)I treatment again after surgery.The Delong test was used to evaluate differences in AUC among different methods(sTg alone,sTg combined with ultrasound,sTg combined with ^(131)I SPECT/CT,and the comprehensive diagnostic model).Results:(1)The serum sTg levels of the lymph node metastasis group(47 cases)and the non-metastasis group(55 cases)were 27.05(10.75,53.79)ng/ml and 4.41(1.71,4.66)ng/ml respectively.The R/M values were 2.15(1.97,2.36)and 1.55±0.20 respectively.The differences were statistically significant(Z=-6.175,-5.719,both P<0.001).The AUC values of sTg and R/M for diagnosing cervical lymph node metastasis in DTC patients who underwent ^(131)I treatment again after surgery were 0.878(95%CI:0.788-0.968)and 0.927(95%CI:0.862-0.991)respectively,and the optimal cut-off values were 22.32 ng/ml and 1.89.(2)The AUC of sTg combined with cervical ultrasound diagnosis was 0.926(95%CI:0.863-0.988)and was not significantly different from that of sTg alone(Z=-1.417,P=0.156).The AUC of sTg combined with ^(131)I SPECT/CT diagnosis was 0.982(95%CI:0.952-1.000),and that of the comprehensive diagnostic model was 0.985(95%CI:0.962-1.000).Both values were significantly higher than the AUC of sTg alone(Z=-2.379,-2.480,P=0.017,0.013).The AUC of the comprehensive diagnostic model was significantly higher than that of sTg combined with cervical ultrasound(Z=-2.008,P=0.045).Conclusion:The comprehensive diagnostic model combining sTg with ^(131)I SPECT/CT and cervical ultrasound can significantly improve the diagnostic efficiency of cervical lymph node metastasis in patients with DTC who underwent ^(131)I treatment again after surgery,this work provides a basis for clinical treatment decisions.
作者
朱雁冬
高春丽
郑中航
苑丽丽
段崇玲
李晓艳
安琳
Zhu Yandong;Gao Chunli;Zheng Zhonghang;Yuan Lili;Duan Chongling;Li Xiaoyan;An Lin(Department of Nuclear Medicine,Jining First People's Hospital,Jining 272000,China;Department of Ultrasound,Jining First People's Hospital,Jining 272000,China)
出处
《国际放射医学核医学杂志》
2025年第7期413-419,共7页
International Journal of Radiation Medicine and Nuclear Medicine
